Telemedicine intervention fails to reduce nursing home hospitalizations, study finds

by JMIR Publications

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Implementing an intersectoral, telemedicine-based intervention in nursing homes did not lead to a statistically significant reduction in patient hospitalizations, according to a prospective, multicenter cluster-randomized trial led by John Grosser, Sophie Pauge, Birthe Aufenberg and Prof. Dr. Wolfgang Greiner from the Department of Health Economics and Health Care Management at Bielefeld University.

The research was conducted alongside Miriam Hertwig, Dr. med. Jenny Unterkofler, Dr. med. Christian Hübel and Prof. Dr. med. Jörg Christian Brokmann from the Department for Acute and Emergency Medicine at University Hospital RWTH Aachen, in collaboration with Dr. med. David Brücken (Rhine-Meuse Hospital Würselen) and the Optimal@NRW Research Group.

Published in JMIR Aging, the study evaluated the Optimal@NRW project across 24 nursing homes in western Germany between May 2021 and April 2023. Designed to address nonemergency hospitalizations and resource shortages in long-term care, the intervention integrated a 24/7 telemedical consultation center, mobile nonphysician medical assistants, a virtual emergency hub and a software-based early warning system for vital signs.

To rigorously evaluate the intervention's effect on hospitalization rates and total days spent in care, the researchers performed a specification curve analysis, evaluating 1,260 distinct mixed-effects regression model specifications across primary data and statutory health insurance claims data. Although roughly two-thirds of the model variations indicated a numerical trend toward reduced hospitalizations, no models demonstrated a statistically significant intervention effect (P < .05).

The authors noted that several practical challenges and external events likely compromised the intervention's success:

• External disruptions: The trial period coincided with severe regional flooding in western Germany and ongoing COVID-19 pandemic restrictions, both of which disrupted facility operations and baseline hospitalization rates.
• Staff workload and usability: Complex, multi-component tasks—such as daily manual vital sign recording—added significant operational stress to nursing staff already facing severe labor shortages.
• Physician integration: Engaging general practitioners (GPs) directly in the telemedical framework proved difficult, limiting the true intersectoral scope of the program.
• Short adaptation windows: Intervention phases lasting 6 to 15 months per group may have been insufficient for staff to fully adapt to digital workflows.

The research team concluded that future digital health interventions in long-term care should target specific, avoidable admission metrics rather than overall hospitalizations. They also recommended extended implementation phases, simplified automated solutions such as wearable monitoring devices, and deeper structural integration with general practitioners.

More information

John Grosser et al, Effect of an Intersectoral Telemedicine Intervention on Hospitalization in Nursing Home Patients: Specification Curve Analysis of a Stepped Wedge Cluster Randomized Trial, JMIR Aging (2026). DOI: 10.2196/75721

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Geriatric palliative careHospital medicineHealthy aging Provided by JMIR Publications Who's behind this story?

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